不同遗传背景的阻塞性睡眠呼吸暂停患者觉醒阈值差异及影响因素

Differences in arousal threshold among obstructive sleep apnea patients of different genetic backgrounds and influencing factors

中文关键词:  觉醒阈值  阻塞性睡眠呼吸暂停  横断面研究

英文关键词:Arousal Threshold,Obstructive Sleep Apnea,Cross-sectional study

中文摘要:

      背景 阻塞性睡眠呼吸暂停（OSA）是一种高发的睡眠呼吸障碍，其病理生理机制复杂。觉醒阈值（ArTH）作为OSA的关键非解剖学机制，与疾病严重程度及临床表现密切相关。然而，目前关于ArTH影响因素的研究结论尚存争议，其在不同遗传背景人群中的特征及差异仍是当前研究的薄弱环节。目的 探索OSA患者ArTH的分布特征及其在不同人群中的差异，分析影响ArTH的关键因素，以期为OSA的病理机制研究及针对性治疗策略的制定提供循证依据。方法 回顾性收集2022年12月—2024年5月在内蒙古自治区精神卫生中心睡眠医学中心接受整夜多导睡眠监测（PSG）、符合《成人阻塞性睡眠呼吸暂停多学科诊疗指南》OSA诊断标准的285例患者为研究对象。根据研究设计，将患者划分为两个不同的遗传背景亚组（以下简称“A组”与“B组”）。采集患者的基本资料、临床资料、Epworth嗜睡量表（ESS）评分及夜间PSG数据；采用睡眠呼吸暂停低通气指数（AHI）、最低脉搏血氧饱和度（LSpO2）及低通气呼吸事件比例（Fhypopneas）作为判断OSA患者ArTH的标准。结果 285例OSA患者中，不同遗传背景OSA患者低ArTH比例、ESS评分及其他一般资料、PSG数据、低ArTH的三条评分标准（呼吸暂停低通气指数<30次/h、最低氧饱和度>82.5%和低通气呼吸事件>82.5%）比较，差异均无统计学意义（P均>0.05）。二元Logistic回归分析结果显示，性别（OR=2.421，95% CI：1.070~5.478）、BMI（OR=0.847，95% CI：0.770~0.932）、N1期睡眠持续时间（OR=0.974，95% CI：0.963~0.985）、高血压（OR=0.348，95% CI：0.143~0.848）是低ArTH的独立影响因素。分层分析显示，在A组OSA患者中，性别、BMI及较短的N1期睡眠持续时间仍为低ArTH的独立影响因素（P均<0.05）；B组OSA患者中，仅较短的N1期睡眠持续时间（OR=0.951，95% CI：0.911~0.993）是低ArTH的独立影响因素。结论 觉醒阈值在不同人群中可能具有保守性特征，但OSA的病理生理机制可能存在人群异质性。

英文摘要:

      Background Obstructive sleep apnea (OSA) is a high incidence of sleep apnea, and its pathophysiological mechanism is complex. As a key non-anatomical mechanism of OSA, the arousal threshold(ArTH) is closely related to the severity and clinical manifestations of the disease. At present, the research conclusions about the influencing factors of ArTH are still controversial, and its characteristics and differences among people with different genetic backgrounds are still the weak link in the current research. Objective To explore the distribution characteristics of ArTH in patients with OSA and its differences in different populations, and analyze the key factors affecting ArTH, so as to provide evidence-based basis for the study of pathological mechanism of OSA and the formulation of targeted treatment strategies. Methods A retrospective analysis was conducted on 285 patients diagnosed with OSA according to the Multidisciplinary Diagnosis and Treatment Guidelines for Adult Obstructive Sleep Apnea, who underwent overnight polysomnography (PSG) at the Sleep Medicine Center of Inner Mongolia Mental Health Center from December 2022 to May 2024. According to the study design, the patients were divided into two different genetic background subgroups (hereinafter referred to as "Group A" and "Group B"). Data collected included basic demographic information, clinical data, Epworth Sleepiness Scale (ESS) scores, and overnight PSG parameters. The apnea-hypopnea index, lowest pulse oxygen saturation, and proportion of hypopneic events were used as criteria to determine the ArTH in OSA patients. Differences in the above indicators were compared between the Han and Mongolian OSA groups. Binary logistic regression analysis was used to identify factors influencing ArTH in the overall OSA population, followed by ethnicity-stratified regression analysis to preliminarily explore ethnic differences in these influencing factors. Results Among the 285 OSA patients, no significant differences were observed between the two groups in the proportion of low ArTH, ESS scores, other general characteristics, PSG parameters, or the proportion of patients meeting the three criteria for low ArTH (apnea-hypopnea index <30 events/h, lowest oxygen saturation >82.5%, and proportion of hypopneic events >58.3%) (P>0.05). Binary logistic regression analysis revealed that female sex (OR=2.421, 95% CI: 1.070–5.478), BMI (OR=0.847, 95% CI: 0.770–0.932), N1 sleep duration (OR=0.974, 95% CI: 0.963–0.985), and hypertension (OR=0.348, 95% CI: 0.143–0.848) were independent influencing factors for low ArTH. Stratified analysis by ethnicity showed that in group A OSA patients, female sex, BMI, and shorter N1 sleep duration remained independent influencing factors for low ArTH (P<0.05), whereas in group B OSA patients, only shorter N1 sleep duration (OR=0.951, 95% CI: 0.911–0.993) was an independent influencing factor for low ArTH. Conclusion arousal thresholdmay have conservative characteristics in different populations, but the pathophysiological mechanism of OSA may have population heterogeneity.